Physician Self-assessment of Shared Decision-making in Simulated Intensive Care Unit Family Meetings

Question Does intensivist self-assessment of communication skills endorsed by professional guidelines align with assessments of the same skills by blinded expert colleagues? Findings In this survey, 76 US intensivists read deidentified transcripts from their intensive care unit family meeting and rated themselves as conveying prognosis, highlighting choice, providing recommendations and offering the option of care focused on comfort. Sixty-one of 76 intensivists reported conveying prognosis, and blinded colleagues agreed that 42 of those 61 had conveyed the patient's risk of death. Meaning Clinicians who lack communication skills endorsed in professional guidelines may also lack the metacognitive skills required to recognize their deficiencies, which makes routine feedback and continuing education on communication and shared decision-making essential at all levels of practice. Importance Professional guidelines have identified key communication skills for shared decision-making for critically ill patients, but it is unclear how intensivists interpret and implement them. Objective To compare the self-evaluations of intensivists reviewing transcripts of their own simulated intensive care unit family meetings with the evaluations of trained expert colleagues. Design, Setting, and Participants A posttrial web-based survey of intensivists was conducted between January and March 2019. Intensivists reviewed transcripts of simulated intensive care unit family meetings in which they participated in a previous trial from October 2016 to November 2017. In the follow-up survey, participants identified if and how they performed key elements of shared decision-making for an intensive care unit patient at high risk of death. Transcript texts that intensivists self-identified as examples of key communication skills recommended by their professional society's policy on shared decision-making were categorized. Main Outcomes and Measures Comparison of the evaluations of 2 blinded nonparticipant intensivist colleagues with the self-reported responses of the intensivists. Results Of 116 eligible intensivists, 76 (66%) completed the follow-up survey (mean [SD] respondent age was 43.1 [8.1] years; 72% were male). Sixty-one of 76 intensivists reported conveying prognosis; however, blinded colleagues who reviewed the deidentified transcripts were less likely to report that prognosis had been conveyed than intensivists reviewing their own transcripts (42 of 61; odds ratio, 0.10; 95% CI, 0.01-0.44; P < .001). When reviewing their own transcript, intensivists reported presenting many choices, with the most common choice being code status. They also provided a variety of recommendations, with the most common being to continue the current treatment plan. Thirty-three participants (43%) reported that they offered care focused on comfort, but blinded colleagues rated only 1 (4%) as explaining this option in a clear manner. Conclusions and Relevance In this study, guidelines for shared decision-making and end of life care were interpreted by intensivists in disparate ways. In the absence of training or personalized feedback, self-assessment of communication skills may not be interpreted consistently. This survey study assesses how the self-assessments of intensivists who read a transcript of their participation in an intensive care family meeting simulation compare with assessments of blinded colleagues reading the same transcript in reporting the performance of key communication skills endorsed by their professional societies.